Telemedicine for Screening and Follow-Up of Glaucoma: A Descriptive Study.

Introduction: Glaucoma is a leading cause of irreversible blindness. It is a prevalent disease worldwide, affecting ∼70 million people and expected to reach up to 112 million by 2040. Purpose: The aim of this study is to describe the implementation and initial experience of a telemedicine program to monitor glaucoma and glaucoma suspect patients in a large, integrated health care system during the COVID-19 pandemic. Methods: A retrospective chart review of established glaucoma or glaucoma suspect patients who participated in a telemedicine evaluation at the ophthalmic center of a large, Colombian health care system between June 2020 and April 2023 was conducted. Clinical and sociodemographic variables were analyzed. Generated clinical orders for additional testing, surgical procedures, follow-ups, and referrals, as well as changes in medical treatment, were evaluated. Results: A total of 11,034 telemedicine consults were included. The mean ± standard deviation age of this group was 63 ± 17.2 years and 67% were female. Of the patients who attended teleconsults, 49% were glaucoma suspects and 38.5% were followed with a diagnosis of open-angle glaucoma. After the consult, 25% of patients were referred to a glaucoma specialist, 40% had additional testing ordered, and 8% had a surgical procedure ordered, mainly laser iridotomy (409 cases). Almost a third of patients returned for subsequent telemedicine visits after the initial encounter. Despite some technical difficulties, 99.8% of patients attended and completed their scheduled telemedicine appointments. Conclusions: A telemedicine program aimed to monitor established glaucoma patients can be successfully implemented. Established patients within an integrated health care system have high adherence to the virtual model. Further research by health care institutions and government agencies will be key to expand coverage to additional populations. Clinical Trial Registration Number: CEIFUS 1026-24.

Avocado Paste Phenolics Mitigate a High-Fat Diet-Induced Plasma HDL Decrease in Male Wistar Rats, by Altering the mRNA Expression of Hepatic SCARB1.

Avocado paste (AP) is the main industrial byproduct of its processing, and retains various phenolic compounds (PCs). PCs are known to normalize the plasma lipid profile, but those from avocado byproducts have been minimally studied. We report the normalizing effects of an AP-derived phenolic extract (PE) on the plasma lipid profile of male Wistar rats. A standard (SD) and high-fat diet (HFD) were formulated, and the same diets were supplemented with 1 g/kg of diet of PE (SD + PE and HFD + PE). Rats were fed these diets during an 8-week period. The HFD induced signs of dyslipidemia, but PE treatment countered the decrease in HDL. Relative mRNA expression (real-time PCR) of the hepatic HDL receptor (SCARB1) increased in both groups (SD + PE and HFD + PE), while the LDR receptor (LDLR) increased in SD + PE group. The mRNA expression of apolipoproteins APOA1 and APOB was unaffected. We conclude that PCs from AP can counter a diet-induced decrease in plasma HDL by acting on the mRNA expression of its hepatic receptor.

Variables que influyen el desempeño de los estudiantes de enfermería de la Universidad del Magdalena en las pruebas SABER PRO

Objetivo: Analizar la relación entre las variables personales, familiares e institucionales con el desempeño en las pruebas SABER PRO del periodo 2016 a 2019 de los estudiantes de enfermería de la Universidad del Magdalena (Colombia). Metodología: Estudio de tipo descriptivo, correlacional. Se realizó el análisis de los puntajes objetivos en los módulos genéricos y específicos de las pruebas SABER PRO, extrayendo los puntajes de los estudiantes de la carrera de Enfermería de la Universidad del Magdalena. Se realizó el análisis descriptivo e inferencial utilizando el programa Infostat/L. Resultados: El desempeño en los distintos módulos de las pruebas SABER PRO se encontró asociado a variables personales como la menor edad, género masculino y área de residencia rural; variables familiares como el acceso a servicio de televisión por cable, la tenencia de computadora y de consola de videojuegos, residir en un hogar permanente y no tener personas a cargo y variables institucionales como el valor intermedio de la matrícula y la tenencia de becas. Conclusiones: Se identificaron variables personales, familiares e institucionales que se relacionan con un mejor desempeño en las pruebas de estado. Estos hallazgos destacan la importancia de considerar múltiples factores tanto individuales como contextuales al abordar la mejora de los resultados académicos y la equidad educativa. Se sugiere que las políticas y programas educativos deberían dirigirse hacia la reducción de las brechas existentes en relación con estas variables, proporcionando un acceso equitativo a recursos y oportunidades de aprendizaje para todos los estudiantes.

Objetivo: Analisar a relação entre variáveis pessoais, familiares e institucionais com o desempenho nas provas SABER PRO de 2016 a 2019 de estudantes de enfermagem da Universidade de Magdalena (Colômbia). Metodologia: Estudo descritivo, correlacional. Foi realizada a análise das pontuações objetivas nos módulos genéricos e específicos dos testes SABER PRO, extraindo as pontuações dos estudantes do curso de Enfermagem da Universidade de Magdalena. Foi realizada uma análise descritiva e inferencial por meio do programa Infostat/L. Resultados: Verificou-se que o desempenho nos diferentes módulos dos testes do SABER PRO está associado a variáveis pessoais como ser mais jovem, do sexo masculino e residir em área rural; variáveis familiares, como acesso ao serviço de televisão a cabo, posse de computador e console de videogame, residência em casa própria e não ter dependentes, e variáveis institucionais, como o valor intermediário da matrícula e ter bolsas de estudo. Conclusões: Foram identificadas variáveis pessoais, familiares e institucionais que estão relacionadas com um melhor desempenho nos testes estaduais. Esses achados destacam a importância de considerar múltiplos fatores, tanto individuais quanto contextuais, ao abordar a melhoria dos resultados acadêmicos e a equidade educacional. Sugere-se que as políticas e programas educacionais sejam direcionados para reduzir as lacunas existentes em relação a essas variáveis, proporcionando acesso equitativo a recursos e oportunidades de aprendizagem para todos os alunos.

Objective: To analyze the relationship between personal, family, and institutional variables with the performance in the SABER PRO tests from 2016 to 2019 of nursing students at the Universidad del Magdalena (Colombia). Methodology: Descriptive correlational study. The analysis of the scores obtained in the generic and specific modules of the SABER PRO tests of the nursing students of the Universidad del Magdalena was carried out. Descriptive and inferential analyses were performed using Infostat/L software. Results: The performance in the different modules of the SABER PRO tests was found to be associated with personal variables such as younger age, male gender, and rural residence; family variables such as access to cable television service, ownership of a computer and video game console, residence in a permanent home and no dependents; and institutional variables such as the mean value of tuition fees and scholarships. Conclusions: Personal, family, and institutional variables were identified that are associated with better performance on state tests. These findings highlight the importance of considering multiple individual and contextual factors, when addressing academic achievement and educational equity. It is suggested that educational policies and programs should be designed to reduce existing gaps in these variables and provide equitable access to resources and learning opportunities for all students.

Experience of a TelEmergency program in Colombia South America: descriptive observational study between 2019 and 2021.

INTRODUCTION: Colombia has 50,912,429 inhabitants, but only 50-70% of the population can effectively access health care services. The emergency room (ER) is a main contributor to the in-hospital care system since up to half of the admissions come through it. Telemedicine has become a tool to facilitate effective access to health care services, improve the timeliness of care, reduce diagnostic variability, and reduce costs associated with health. The aim of this study is to describe the experience of a Distance Emergency Care Program through Telemedicine (TelEmergency) to improve specialist access for patients at the Emergency Room (ER) in low- and medium-level care hospitals in Colombia. METHODS: An observational descriptive study of a cohort including 1,544 patients during the program's first two years was conducted. Descriptive statistics were used to analyze the available data. The data are presented with summarized statistics of sociodemographic, clinical, and patient-care variables. RESULTS: The study included a total of 1,544 patients, and the majority were adults between 60 and 79 years of age (n = 491, 32%). More than half were men (n = 832, 54%), and 68% (n = 1,057) belonged to the contributory health care regime. The service was requested from 346 municipalities, 70% (n = 1,076) from intermediate and rural settings. The most common diagnoses were related to COVID-19 (n = 356, 22%), respiratory diseases (n = 217, 14%), and cardiovascular diseases (n = 162, 10%). We observed 44% (n = 681) of local admissions either under observation (n = 53, 3%) or hospitalization (n = 380, 24%), limiting the need for hospital transfers. Program operation data revealed that 50% (n = 799) of requests were answered within two hours by the medical staff. The initial diagnosis was modified in 7% (n = 119) of the patients after being evaluated by specialists at the TelEmergency program. CONCLUSIONS: This study shows the operational data collected during the first two years after the implementation of the TelEmergency program in Colombia, the first of its kind in the country. Its implementation offered specialized timely management of patients at the ER in low- and medium-level care hospitals, where there is no availability of specialized doctors.

Síndrome de burnout en trabajadores del área de Enfermería hospitalaria de Ciénaga, Colombia / Burnout syndrome in workers at the hospital nursing area in Ciénaga, Colombia

Objetivo: determinar la prevalencia del síndrome de burnout en los profesionales de Enfermería que trabajan en el área de atención hospitalaria en el municipio de Ciénaga, Magdalena (Colombia).Método: estudio descriptivo transversal con 64 trabajadores del área de Enfermería, a los cuales se les aplicó el Maslach Burnout Inventory con sus tres dimensiones: agotamiento emocional, despersonalización y realización. El cuestionario fue autoadministrado en línea. Se llevó a cabo estadística descriptiva y la prueba de correlación no paramétrica de Rho de Spearman para calcular correlación entre las variables sociodemográficas y profesionales, y las tres dimensiones del burnout.Resultados: de los 64 participantes estudiados, el 100% era de género femenino, con una mayor participación en edades entre 25 y 31 años (28,1%). Un 46,9% era soltera, la gran mayoría tenía un contrato de prestación de servicios (90,6%) y un 64,1% tenía un nivel de escolaridad de técnico. El 71,9% presentó un agotamiento emocional medio-bajo, el 73,4% manifestó un bajo nivel de despersonalización y prácticamente todas (93,8%) tenían un nivel bajo de realización, no teniendo ninguna un nivel alto. Se halló una correlación positiva baja (Rho= 0,322; p= 0,021) entre la edad y la despersonalización.Conclusiones: los niveles de burnout en los profesionales de Enfermería son medio-bajos, pero destaca el bajo nivel de realización personal que tienen las enfermeras. A pesar de que se halló una débil correlación positiva entre la edad y la despersonalización, el bajo número de participantes sugiere que se interprete con cautela, siendo necesaria más investigación al respecto.(AU)

Objective: to determine the prevalence of burnout syndrome in Nursing professionals working at the hospital care area in the Ciénaga district, Magdalena (Colombia).Method: a descriptive cross-sectional study with 64 workers from the Nursing area, who answered the Maslach Burnout Inventory with its three dimensions: emotional exhaustion, depersonalization and personal achievement. The questionnaire was self-administered on-line. Descriptive statistics was conducted, and the non-parametric Spearman Rank Correlation Coefficient was applied to calculate the correlation between sociodemographic and professional variables, and the three burnout dimensions.Results: of the 64 participants studied, 100% were female, with higher participation in ages from 25 to 31 years (28.1%); 46,9% were single, the vast majority had a service contract (90.6%) and 64.1% had a technician level of education. The results were that 71.9% presented medium-low emotional exhaustion, 73.4% reported a low level of depersonalization, and practically all of them (93.8%) had a low level of personal achievement, with none presenting a high level. There was a low positive correlation (Rho= 0.322; p= 0.021) between age and depersonalization.Conclusions: burnout levels in Nursing professionals are medium-low; but the low level of personal achievement among nurses stands out. Even though a weak positive correlation was found between age and depersonalization, the low number of participants suggests that this should be carefully interpreted, and further research on the matter is required.(AU)

Risk factors for microcystic macular oedema in glaucoma.

BACKGROUND/AIMS: To identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG). METHODS: We included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded. The inner nuclear layer was qualitatively assessed for the presence of MME. Global mean deviation (MD) and Visual Field Index (VFI) decay rates, superior and inferior MD rates and pointwise total deviation rates of change were estimated with linear regression. Logistic regression was performed to identify baseline factors associated with the presence of MME and to determine whether MME is associated with progressive VF loss. RESULTS: 25 out of 315 eyes (7.9%) demonstrated MME. The average (±SD) age and MD in eyes with and without MME was 57.2 (±8.7) versus 62.0 (±9.9) years (p=0.02) and -9.8 (±5.7) versus -4.9 (±5.3) dB (p<0.001), respectively. Worse global MD at baseline (p=0.001) and younger age (p=0.02) were associated with presence of MME. ERM was not associated with the presence of MME (p=0.84) in this cohort. MME was not associated with MD and VFI decay rates (p>0.49). CONCLUSIONS: More severe glaucoma and younger age were associated with MME. MME was not associated with faster global VF decay in this cohort. MME may confound monitoring of glaucoma with full macular thickness.

Structural-Functional Glaucoma Progression Trajectory in 2-Dimensional Space.

PRCIS: We describe a method that provides rapid visualization of glaucomatous change in a 2-dimensional (2D) structural and functional (S/F) space. PURPOSE: To describe a method to visualize glaucomatous change in a 2D S/F space. DESIGN: This was a retrospective longitudinal observational study. SUBJECTS: Group I included 64 normal and 64 glaucomatous eyes used to develop the structural score. Group II included 957 glaucomatous eyes used to plot the structural-functional progression vectors. METHODS: Subjects were arranged in 2 groups. Group I was a cross-sectional group used to develop a structural score which were applied to longitudinal measurements of patients in group II for vectoral analysis. Visual field index was used as a functional score. Vectors were created for each eye to define structural (x) and functional (y) progression. The structural and functional components were calculated with linear models of optical coherence tomography scores and visual field index. The resultant vector and its confidence interval were plotted in 2D S/F space. MAIN OUTCOME MEASURES: Combined structural-functional glaucomatous progression. RESULTS: Group I included 64 normal and 64 glaucomatous eyes. We calculated 957 vectors (957 eyes of 582 OAG patients) in group II. The mean (±SD) follow-up period was 6.9 (±1.5) years and mean baseline mean deviation (MD) was -4.3 (±5.4). Preperimetric, mild, moderate, and severe groups included 159, 288, 299, and 211 eyes, respectively. Mean baseline MDs in these groups were 0.8, -1.0, -3.7, and -11.2 dB, and mean vector slopes were 0.88, 1.00, 1.98, and 2.69. CONCLUSION: We present a method that presents glaucoma progression in a 2D S/F space. This approach integrates a large amount of longitudinal numerical data and provides the clinician with a rapid and intuitive summary of the patient's glaucoma trajectory.

Nutrition, obesity, and dental development in young adolescents in Chicago.

OBJECTIVES: Childhood obesity is a systemic disease with multiple downstream consequences, including shifts in timing of growth and development. It has been documented that children with high body mass index (BMI) show accelerated timing of dental development, but the mechanism for this acceleration is unknown. Prior work has suggested that inflammation and/or nutrition may play a role. We investigate the potential association between diet (caloric intake, macronutrients), obesity, and accelerated dental development. METHODS: Children and adolescents (age 10-15; n = 112) were recruited from dental clinics at the University of Illinois Chicago. We collected subjects' height, weight, panoramic radiographic records, and each subject filled out a Block Food Frequency Questionnaire. RESULTS: The only macronutrient level associated with BMI was a negative correlation to Total Fat consumption (p = .01), though this relationship was not significant in the path analysis (p > .05). Regression analyses indicated that BMI (p = .003) and total caloric intake (controlling for BMI; rho = 0.19; p = .04) were both significantly correlated with timing of dental development. However, when a path analysis was conducted, it was revealed that only BMI was statistically significant (p = .008). CONCLUSIONS: Body mass index percentile, regardless of caloric intake, is positively associated with accelerated dental development. While it is possible that excess caloric intake itself plays a minor role in timing of dental development, we do not see unambiguous evidence for this in our sample. We posit that another mechanism, such as inflammation, may be the link between obesity status and dental development.

Sub-chronic consumption of a phenolic-rich avocado paste extract induces GLP-1-, leptin-, and adiponectin-mediated satiety in Wistar rats.

Avocado paste (AP) is a phenolic-rich byproduct of avocado oil extraction. The effects of sub-chronic consumption of diets supplemented with an AP phenolic extract (PE) were analyzed. A standard diet (SD), high-fat diet (HFD), and these supplemented with PE (SD + PE and HFD + PE) were used. Significantly increased satiety was observed in PE-supplemented groups, according to less food consumption (-15% in SD + PE vs. SD, and -11% in HFD + PE vs. HFD), without changes in weight gain or percentage of adipose tissue. PE-supplemented groups had an increased plasma concentration ( + 16% in SD + PE vs. SD, and +26% in HFD + PE vs. HFD) and relative mRNA expression (+74% in SD + PE vs. SD, and +46% in HFD + PE vs. HFD) of GLP-1; an increase in plasma leptin and adiponectin was independent of their mRNA expression. Our results suggest that AP-derived PE exerts a satiety effect in vivo, possibly mediated by GLP-1, leptin, and adiponectin. PRACTICAL APPLICATIONS: Minimizing food waste is a top priority in most of the world, thus, researchers seek methods to reintroduce industrial fruit and vegetable byproducts into the food processing chain. The present work highlights the potential of avocado byproducts as sources of bioactive phenolic compounds, whose sub-chronic consumption (8 weeks) exerts a satiety action in vivo. Avocado farming is resource-intensive, making it of relevance to producers and processing industries to avoid discarding its byproducts as much as possible.

Phenolic compounds that cross the blood-brain barrier exert positive health effects as central nervous system antioxidants.

The blood-brain barrier (BBB) is a physical structure whose main function is to strictly regulate access to circulating compounds into the central nervous system (CNS). Vegetable-derived phenolic compounds have been widely studied, with numerous epidemiologic and interventional studies confirming their health-related bioactivities across multiple cells, organs and models. Phenolics are non-essential xenobiotics, and should theoretically be unable to cross the BBB. The present work summarizes current experimental evidence that reveals that not only are phenolic compounds able to cross the BBB and bioaccumulate in the brain, but there is some stereoselectivity, which suggests the presence of specific transporters that allow them to reach the brain. Some molecules cross the BBB intact, while others do so only after being biotransformed or metabolized elsewhere. Once inside the CNS, they prevent or counter oxidative stress, which maintains the molecular, cellular, structural and functional integrity of the brain, and subsequently, overall human health.

Spontaneous thrombosis of a vein of Galen malformation associated with acute sinusitis: a case report.

The vein of Galen malformation is caused by an abnormal shunting between choroidal arteries and the median prosencephalic vein during embryological development, leading to increased blood flow to the deep cerebral veins, intracranial damage, and systemic repercussions. Idiopathic spontaneous thrombosis of a vein of Galen malformation is rare, and its association with acute sinusitis has not been reported in the literature. We present the case of a girl with a postnatal diagnosis of a vein of Galen malformation at the age of 16 months, with secondary pulmonary hypertension that was adequately controlled with spironolactone. At 3 years old, while expecting elective endovascular treatment, the patient developed spontaneous thrombosis of the vein of Galen malformation, concomitant to an acute sinusitis episode, with complete resolution of the vascular malformation and secondary pulmonary hypertension. The patient continued with normal neurological development over a 5-year follow-up. We discuss the main pathophysiologic mechanisms that can explain spontaneous thrombosis of VOGMs and the patient's outcome. Awareness of different mechanisms that can lead to spontaneous thrombosis can help in the decision-making process and prompt targeted approaches to individual patients with a vein of Galen malformation.

Association between Family Functionality and Depression: A Systematic Review and Meta-Analysis.

BACKGROUND: Different scales have attempted to assess various aspects of family dynamics and structures. Good family function seems to allow for better prognoses for basic diseases and appears to be a predictor of depression. The aim of this study was to determine the association between family functionality and depression. METHODS: This is a systematic review and meta-analysis including cross-sectional, cohort, and case-control studies using validated instruments such as the Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve) and Family Adaptability and Cohesion Evaluation Scale III. A search strategy was designed for the MEDLINE, Embase, Central, and LILACS databases along with data saturation through a search of unpublished literature from the onset of the databases to the present. The categorical variables are expressed in terms of odds ratios (OR), and the statistical analysis was carried out using Review Manager ver. 5.31 (The Cochrane Collaboration, Oxford, UK) using forest plots with corresponding 95% confidence intervals (CI). A fixed-effect model was used according to the expected heterogeneity, expressed in terms of I2 . The risk of bias was evaluated using the MINORS (methodological index for non-randomized studies) tool. RESULTS: A total of 1,519 studies were found, of which 10 were selected for the qualitative synthesis and four were chosen for the meta-analysis. The result for the association between family dysfunction and depression yielded an OR (95% CI) of 3.72 (2.70 to 5.12) and I2 of 24%. CONCLUSION: Family dysfunction and depression are strongly associated.

Efficacy of Combined Suprachoroidal Stent and Cataract Surgery in Patients With Glaucoma.

PURPOSE: The purpose of this study was to evaluate the efficacy of intraocular pressure (IOP) control after combined CyPass Micro-Stent implantation and cataract surgery (combined surgery). METHODS: All cases of combined surgery performed from February 2017 to July 2018 at Stein and Doheny Eye Institutes were reviewed. The primary outcome was a qualified success with stratified IOP targets based on criteria: final IOP (A) ≤18 mm Hg and reduction of 20%, (B) ≤15 mm Hg and reduction of 25%, (C) ≤12 mm Hg and reduction of 30%. Secondary outcome measures included postoperative IOP and number of medications, complications, additional glaucoma surgery, and postoperative refractive error. Predictive factors for failure were investigated. IOP spike was defined as a postoperative IOP ≥30 or >10 mm Hg increase from preoperative IOP. RESULTS: One hundred forty-one eyes (107 patients) were included. Mean (±SD) preoperative IOP was 15.4±3.4 mm Hg on an average of 2.2±1.1 medications. A statistically significant reduction in IOP and number of medications was seen at 12 months (13.8±4.2 mm Hg, 1.3±1.3 medications, P<0.001). Fifteen eyes (10.6%) had a postoperative IOP spike. Thirteen eyes (9.2%) experienced 17 complications (12.1%). Additional glaucoma surgery was performed in 3 eyes (2 patients). Cumulative success rates at 1 year based on criteria A, B, and C were 42%, 33%, and 28%, respectively. Lower preoperative IOP, greater preoperative medication number, the occurrence of postoperative IOP spike, and non-Caucasian ethnicity were associated with failure. CONCLUSION: Combined CyPass Micro-Stent implantation and cataract surgery may reduce glaucoma medication burden with a success rate of 28% to 42% at 1 year.

Pointwise Methods to Measure Long-term Visual Field Progression in Glaucoma.

Importance: Rates of visual field (VF) progression vary among patients with glaucoma. Knowing the rate of progression of individual patients would allow appropriately aggressive therapy for patients with high rates of visual loss and protect those with low rates from unnecessary therapy. Objective: To compare 3 pointwise methods of estimating the rate of VF progression in glaucoma. Design, Setting, and Participants: This retrospective, observational cohort study included 729 eyes of 567 consecutive patients with primary open-angle glaucoma who had at least 6 reliable VFs and at least 3 years of follow-up. One hundred seventy-six patients (257 eyes) were treated at a tertiary glaucoma center; in addition, data were collected from 391 participants (472 eyes) in the Advanced Glaucoma Intervention Study. Data were collected from May 1988 to November 2004 and analyzed from October 2018 to February 2019. Exposures: Estimates of VF progression were measured with guided progression analysis (GPA), pointwise linear regression (PLR), and the glaucoma rate index (GRI). A subgroup analysis was performed in a subset of patients with likely VF progression and likely VF stability. Main Outcomes and Measures: Proportion of VF series detected as progressing, estimates of false-positive proportions, time to detect progression, and agreement among measures. Results: Among the 567 patients included in the analysis, mean (SD) age was 65.6 (9.7) years, 300 (52.9%) were female, and 295 (52.0%) were white. The median baseline mean deviation was -6.7 (interquartile range [IQR], -11.6 to -3.5) dB; the median follow-up time, 8.9 (IQR, 7.3-10.4) years. The proportion of eyes labeled as progressing was 27.7% according to the GPA, 33.5% according to the PLR, and 52.9% according to the GRI; pairwise differences for GRI vs PLR were 20% (95% CI, 17%-23%); for GRI vs GPA, 25% (95% CI, 22%-29%); and for PLR vs GPA, 6% (95% CI, 3%-9%; P < .001 for all comparisons, McNemar test). The shortest median time to progression was with the GRI (8.8 [IQR, 2.4-10.5 years), compared with the GPA and PLR (both >16 years). The hazard ratio of VF progression for GRI vs PLR (reference) was 11.3 (95% CI, 9.2-13.7); for GRI vs GPA (reference), 18.1 (95% CI, 14.5-22.6); and for PLR vs GPA (reference), 1.5 (95% CI, 1.3-1.9; P < .001 for all comparisons, Cox proportional hazards regression). These results held in the subgroup with likely progression; the proportions of progressing eyes were 73.7% (115 of 156) for GPA, 81.4% (127 of 156) for PLR, and 92.9% (145 of 156) for GRI. Pairwise difference for GRI vs PLR was 11.5% (95% CI, 7.4%-17.6%; P < .001, McNemar test); for GRI vs GPA, 19.2% (95% CI, 12.6%-26.4%; P < .001, McNemar test); and for PLR vs GPA, 7.7% (95% CI, 0.3%-15.7%; P = .08, McNemar test). Conclusions and Relevance: These results suggest GRI can detect long-term VF progression in glaucoma earlier than PLR or GPA. Validation with prospective designs may strengthen the generalizability and value of this method.

Glaucoma After Iodine-125 Brachytherapy for Uveal Melanoma: Incidence and Risk Factors.

PRéCIS:: A single-center retrospective review over a 10-year period discovered an 8.6% risk of developing secondary open-angle glaucoma, and a 6.7% risk of neovascular glaucoma after brachytherapy for uveal melanoma. Additional risk factors were identified. PURPOSE: To report the incidence and identify risk factors for secondary open-angle glaucoma and neovascular glaucoma after iodine-125 brachytherapy for uveal melanoma in a tertiary ocular oncology and glaucoma practice. PATIENTS AND METHODS: Eyes of patients who had been diagnosed and treated with iodine-12 brachytherapy for uveal melanoma over a 10-year period were included for review. Secondary open-angle glaucoma was defined as meeting the following criteria: at least 3 measurements of intraocular pressure (IOP) ≥21 mm Hg after the removal of the iodine-125 plaque and an open angle on gonioscopy. Neovascular glaucoma was defined as meeting the following criteria: at least 3 measurements of IOP ≥21 mm Hg and neovascularization of the iris or anterior chamber angle. Cumulative incidence was calculated and survival analysis was used to analyze risk factors for both secondary open-angle glaucoma and neovascular glaucoma. RESULTS: A total of 374 eyes in patients diagnosed with uveal melanoma and treated with Iodine-125 brachytherapy were included in the study. Thirty-one eyes (8.6%) were diagnosed with secondary open-angle glaucoma and 25 eyes (6.7%) were diagnosed with neovascular glaucoma. Multivariate analysis identified the following risk factors for secondary open-angle glaucoma: older age, greater tumor size, iris location of uveal melanoma, higher baseline IOP, ciliary body involvement, and eyes having undergone combined brachytherapy with vitrectomy and silicone oil placement for radiation attenuation. The risk factors for neovascular glaucoma were as follows: greater tumor size, greater number of pack-years smoking history, pseudophakia, and higher grade of radiation retinopathy severity by fluorescein angiogram. CONCLUSIONS: We have identified additional risk factors for the development of both secondary open-angle glaucoma and neovascular glaucoma in patients with uveal melanoma who have undergone iodine-125 brachytherapy for local tumor control. The risk of secondary glaucoma is substantial. Close ophthalmic monitoring of patients is necessary for detection and timely treatment of glaucoma to maximize visual outcome.

Influencia de la dinamica familiar en el cuidado de gestantes adolescentes en una comunidad de Santa Marta - Colombia / Influence of family dynamics in the care of adolescent gestants in a community of Santa Marta ­ Colombia

En el presente estudio se buscó describir la influencia de la dinámica familiar en el cuidado de la salud en un grupo de gestantes adolescentes de un barrio de la ciudad de Santa Marta, Colombia. Se realizó un estudio descriptivo, utilizando la técnica de muestro no probabilística intencional o por conveniencia conformado por 36 gestantes adolescentes residentes en un barrio de la ciudad de Santa Marta, Colombia. Utilizando el familiograma y test de Apgar familiar como instrumento, se indagaron además algunos datos sociodemográfico para caracterizar la población. Los criterios de inclusión fueron ser gestante adolescente sin patologías agregadas, residentes en el barrio y aceptar la participación voluntaria en el estudio previo firma de consentimiento informado. El familiograma presentó el 100% malas relaciones con sus padres y en el test de Apgar familiar solo el 41,6% mostró buena función familiar el resto de la población estudiada presentó algún grado de disfunción familiar. Este estudio encontró similitud con lo hallado por otros estudios en cuanto al funcionamiento familiar ya que se ha destacado la importancia del apoyo familiar afirmando que aumenta en la gestante los sentimientos de eficacia y los recursos para hacer frente al proceso del embarazo.

In this study, we sought to describe the influence of family functioning on health care in a group of pregnant adolescents from a neighborhood in the city of Santa Marta, Colombia. A descriptive study was carried out, using the technique of intentional non-probabilistic sampling or by convenience formed by 36 pregnant teenagers living in a neighborhood of the city of Santa Marta, Colombia. Using the family Apiogram and family test as an instrument, some sociodemographic data were also investigated to characterize the population. The inclusion criteria were to be a pregnant adolescent without added pathologies, residents in the neighborhood and to accept voluntary participation in the study before signing informed consent. The familiogram showed 100% bad relationships with their parents and in the family Apgar test only 41.6% showed good family function. The rest of the population studied showed some degree of family dysfunction. This study found similarity with that found by other studies in terms of family functioning, since the importance of family support has been stressed, stating that it increases in the pregnant woman the feelings of efficacy and the resources to face the pregnancy process.

Cuidado al familiar del paciente críticamente enfermo desde la teoría de Callista Roy / Caring for the relative of the critically ill patient from Callista Roy's theory

Se realizó un estudio cuantitativo, con un nivel y método descriptivo-transversal, su objetivo fue Determinar el nivel de afrontamiento y adaptación de los familiares del paciente adulto hospitalizado en una unidad de cuidados intensivos adultos de la ciudad de Santa Marta. La población está conformada por los familiares de los pacientes hospitalizados en una unidad de cuidado intensivos adultos de Santa Marta. La muestra estuvo constituida por 216 familiares de pacientes ingresados a una UCI en la ciudad de Santa Marta, para seleccionar a los participantes en el estudio se realizó un muestreo aleatorio sistemático. Los resultados indican que el nivel de afrontamiento y adaptación de los familiares del paciente adulto hospitalizado en una unidad de cuidados intensivos en Santa Marta, se determinó como Medio-Bajo, con un promedio de 62 puntos. Se concluye que no hay valores extremos entre un nivel y otro, lo que refleja de alguna manera que están presentes los tres niveles de afrontamiento y adaptación: bajo, medio y alto.

A quantitative study was carried out, with a descriptive-transversal level and method, its objective was to determine the level of coping and adaptation of the relatives of the adult patient hospitalized in an adult intensive care unit of the city of Santa Marta. The population is made up of the relatives of patients hospitalized in an intensive care unit in Santa Marta. The sample was constituted by 216 relatives of patients admitted to an ICU in the city of Santa Marta, to select the participants in the study, a systematic random sampling was carried out. The results indicate that the level of coping and adaptation of the relatives of the adult patient hospitalized in an intensive care unit in Santa Marta, was determined as Medium-Low, with an average of 62 points. It is concluded that there are no extreme values between one level and another, which reflects in some way that the three levels of coping and adaptation are present: low, medium and high.

Estilos de aprendizaje de los estudiantes de enfermería en la asignatura Morfofisiología I, en una universidad pública de Santa Marta / Learning styles of nursing students in the subject Morphophysiology I, in a public university of Santa Marta

Se realizó un estudio cuantitativo, con un nivel y método descriptivo-transversal, su objetivo fue determinar los estilos de aprendizaje de los estudiantes de III semestre del programa de Enfermería en el periodo 2018-I, en la asignatura de Morfofisiologia I de la Universidad del Magdalena, Santa Marta. La población está constituida por los 369 estudiantes matriculados del programa de Enfermería, el tamaño de la muestra, son los estudiantes matriculados en la asignatura de Morfofisiología en el I periodo de 2018. Por su parte, la muestra en total fueron 50 estudiantes a los cuales se les aplico el instrumento. Los resultados indican que los estudiantes matriculados en la asignatura de Morfofisiología I tienen preferencia alta por el estilo de aprendizaje activo con un porcentaje del 60%. Se concluye que hay una tendencia moderada por todos los estilos de aprendizaje de acuerdo con el baremo y en el estilo de aprendizaje pragmático la preferencia fue baja para todas las edades.

A quantitative study was carried out, with a level and descriptive-transversal method, its objective was to determine the learning styles of the students of the III semester of the Nursing program in the period 2018-I, in the subject of Morphophysiology I of the University of Magdalena, Santa Marta. The population is constituted by the 369 enrolled students of the Nursing program, the size of the sample, are the students enrolled in the subject of Morphophysiology in the I period of 2018. For its part, the sample in total were 50 students to whom the instrument was applied. The results indicate that students enrolled in the subject of Morphophysiology I have high preference for active learning style with a percentage of 60%. It is concluded that there is a moderate tendency for all learning styles according to the scale and in the pragmatic learning style the preference was low for all ages.

Cuidado de enfermería en la salud mental de los niños de 5 a 14 años, Santa Marta - Colombia / Nursing care in the mental health of children from 5 to 14 years old, Santa Marta ­ Colombia

La investigación se desarrolló en tres etapas que conjugan una metodología descriptiva cuantitativa con una fase de intervención con características de acción participativa, se inició con un diagnóstico comunitario en salud mental, luego una intervención y evaluación del impacto social de las intervenciones de enfermería en el área de salud mental, que tuvo por objetivo: medir la efectividad del cuidado de Enfermería en el fomento de la salud mental efectuado por los estudiantes y docentes del Programa de la Universidad del Magdalena en los niños de 5 a 14 años del barrio Simón Bolívar de Santa Marta (2013-II al 2015-II), para detectar alteraciones en el comportamiento y desarrollo en los niños se utilizó el instrumento Cuestionario de síntomas para niños (RQC) diseñado y valorado en el marco colaborativo de la Organización Mundial de la Salud. Los hallazgos encontrados para la población de 5 a 9 años en el 2013-2 fue de un 19% para posibles alteraciones en salud mental y en 2015-2 se encontró un 16% de los menores afectados, y para la población de 10 a 15 años se encontró en el 2013-2 un 23% y para el 2015-2 un 13%.

The research refers to 3 stages that combine a quantitative descriptive methodology with an intervention phase with characteristics of participatory action, begins with a diagnosis in mental health, then an intervention and evaluation of the social impact of nursing functions in the mental health area, which had an objective: to measure health care in the promotion of mental health effect of students and teachers of the Magdalena University Program in children from 5 to 14 years of the Simón Bolívar de Santa Marta (2013-II to 2015-II), to detect alterations in behavior and development in children, as well as the RQC instrument designed and evaluated in the collaborative framework of OMS. The findings found for the population from 5 to 9 years in 2013-2 were 19% for possible alterations in mental health and in 2015-2 are found in 16% of children, and for the population of 10 to 15 in 2013-2 23% and for 2015-2 in 13%.

Microorganismos periodontales en el líquido sinovial de pacientes con artritis reumatoide. Revisión sistemática de la literatura 2017 / Periodontal microorganisms in synovial fluid of patients with rheumatoid arthritis. Systematic review of the literature - 2017

RESUMEN Introducción: La enfermedad periodontal (EP) y la artritis reumatoide (AR) son enfermedades inflamatorias crónicas multifactoriales que tienen en común algunos factores etiopatogénicos y la destrucción de los tejidos dentoalveolares y de las articulaciones sinoviales, de tal forma que se han identificado anticuerpos contra microorganismos periodontales en el fluido crevicular, líquido sinovial y en la membrana sinovial. Objetivo: Identificar, recuperar, analizar críticamente y sintetizar la literatura disponible acerca de la prevalencia de microorganismos periodontales en el líquido sinovial de pacientes con AR. Materiales y métodos: Se realizó búsqueda sistemática en Medline, ScienceDirect, SciELO y Google Scholar a través de los descriptores en salud Rheumatoid arthritis, periodontal microorganisms y synovial fluid. Se incluyeron artículos que describieron la presencia de microorganismos periodontales aislados en líquido sinovial de pacientes diagnosticados con AR. La búsqueda se cerró en febrero de 2017 y fue realizada con metodología PRISMA. Se emplearon las fichas de lectura crítica OSTEBA para valorar la validez externa y el nivel de evidencia de cada artículo en función del rigor metodológico. Resultados: Catorce publicaciones describieron la presencia de microorganismos periodontales en líquido sinovial de pacientes con EP y AR. Seis publicaciones realizaron detección de microorganismos periodontales en muestras de líquido sinovial, identificando en todas a P. gingivalis. Conclusiones: Los estudios incluidos evidenciaron la presencia de microrganismos periodontales en el líquido sinovial en sujetos con EP y AR, asociando la prevalencia de P. gingivalis con el aumento de los niveles de anticuerpos anti-CCP, lo que podría exacerbar los procesos inflamatorios y producir reacciones autoinmunes en AR.

ABSTRACT Introduction: Periodontal disease (PD) and rheumatoid arthritis (RA) are multifactorial chronic inflammatory diseases that share similar aetiopathogenic mechanisms that lead to the destruction of both dental-alveolar tissues and synovial joints, in such way that antibodies against periodontal pathogens have been identified in the crevicular fluid and in the synovial fluid and membranes. Objective: To identify, recover, critically analyze and synthesize the available literature on the prevalence of periodontal microorganisms in synovial fluid of patients with RA. Materials and methods: A systematic search was performed in MEDLINE, ScienceDirect, SciELO and Google Scholar using the medical subject headings "Rheumatoid arthritis", "periodontal microorganisms" and "synovial fluid". Articles were included that described the presence of isolated periodontal pathogens in synovial fluid of patients diagnosed with RA. The search was closed in February 2017 and was performed using PRISMA methodology. The OSTEBA critical reading sheets were used to assess the external validity and level of evidence of each article in terms of methodological rigor. Results: A total of 14 publications were included that described the presence of periodontal pathogens in synovial fluid of patients with PD and RA. Seven publications detected periodontal pathogens in synovial fluid, with P. gingivalis being positive in all of them. Conclusions: The included studies provided evidence of the presence of periodontal microorganisms in the synovial fluid in subjects with PD and RA, associating the prevalence of P. gingivalis with increased levels of anti-cyclic citrullinated peptide (anti-CCP) antibodies, which could exacerbate inflammatory processes and produce autoimmune reactions in RA.